[COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics]. / COVID-19 und psychische Störungen bei Minderjährigen: Veränderungen der Behandlungen nach der Krankenhausstatistik.

COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics Abstract: Increased rates of psychiatric disorders and psychiatric emergencies in children and adolescents stemming from the COVID-19 pandemic have been reported, with more children and adolescents suffering from internalizing disorders. This study analyzes whether the increased rates led to increased rates of inpatient treatment in child and adolescent psychiatric and pediatric hospitals in Germany as well as a change in diagnoses of the treated patients. We analyzed routine hospital data ("InEK" data, § 21 KHG data files) from a prepandemic (2019) and a pandemic (2021) half-year regarding changes in the number of cases, diagnoses, and length of stay (LoS) in child and adolescent psychiatry and pediatrics. We also investigated the development of psychiatric emergencies in minors. We found an increase in internalizing problems (depression, anorexia nervosa, trauma-related disorders) and a decrease in externalizing problems among the admitted psychiatric inpatients. Further, we observed a halving of cases treated for alcohol intoxication. However, we discovered no change for the frequency of psychiatric emergency treatments nationwide. A more detailed analysis revealed that, in areas with a low number of child and adolescent psychiatry inpatient beds, emergency care was prioritized and LoS decreased, whereas in areas with a fair bed-to-inhabitant ratio among minors, there was a trend toward increased LoS, also in pediatric departments. We recommend continued monitoring of inpatient care after the pandemic, with special attention paid to underprivileged children and adolescents such as those with externalizing problems.

Who decides? Consent for healthcare decisions of minors in the United States.

PURPOSE OF REVIEW: The purpose of this review is to examine when parents and legal guardians have the authority to make medical decisions on behalf of the minors in their care, when the decisions of healthcare professionals may supersede those of parents and guardians, and under what conditions minors can make healthcare decisions for themselves. RECENT FINDINGS: The coronavirus disease 2019 (COVID-19) pandemic has reignited discussion of who should make healthcare decisions for minors. Though serious adverse reactions to COVID-19 vaccines are rare, hesitancy toward pediatric COVID-19 vaccination is prevalent among parents in the United States. This has contributed to large numbers of minors who are not up-to-date or not fully vaccinated against severe acute respiratory syndrome coronavirus 2 infection. Surveys reveal a majority of minors in the United States are willing to receive a COVID-19 vaccine. A number of scholars have recommended allowing adolescents the ability to consent to COVID-19 vaccination without parental approval. SUMMARY: Allowing adolescents with a minimum age of 15 to consent to vaccination without parental or guardian approval will more quickly enable adolescents to receive new vaccines as they become available, such as the COVID-19 bivalent vaccine.

Minors' Experiences Accessing Confidential Contraception in Texas.

PURPOSE: Texas is one of 24 states that restricts minors' ability to obtain contraception without parental consent, unless they access confidential services at federally funded Title X clinics. This study explores Texas minors' reasons for and experiences seeking confidential contraception. METHODS: Between September 2020 and June 2021, we conducted in-depth phone interviews with 28 minors aged 15-17 years. Participants were recruited via the text line and Instagram account of an organization that helps young people navigate Texas' parental consent laws. Interview transcripts were coded and analyzed using inductive and deductive codes in our thematic analysis. RESULTS: Participants wanted to be proactive about preventing pregnancy by using more effective contraceptive methods but faced resistance from adults when they initiated conversations about sex and contraception or tried to obtain consent. In the absence of adult support, they turned to online and social media resources for information about types of contraception but encountered challenges finding accurate information about where to obtain methods in Texas without a parent. Only 10 participants were able to attend an appointment for contraception. Parents' increased monitoring of minors' activities during the COVID-19 pandemic, combined with transportation and appointment-scheduling barriers, made it difficult for minors to attend in-person visits, particularly if clinics were farther away. DISCUSSION: Minors in Texas faced a range of barriers to finding accurate information and obtaining confidential contraceptive services, which were exacerbated by the COVID-19 pandemic. Expanding options for accessible confidential contraception, along with repealing parental consent laws, would better support minors' reproductive autonomy.

Health and Vaccination Status of Unaccompanied Minors After Arrival in a European Border Country: A Cross-sectional Study (2017-2020).

BACKGROUND: Unaccompanied and separated children (UASC) are a high-risk group for infectious diseases and information on their vaccination status is scarce. Different approaches are used to screen newly arrived minors in Europe. The aim of this study was to describe the health status and serological protection against different vaccine-preventable diseases among UASC to inform public health decision-making. METHODS: Retrospective study of all UASC seen at an international health reference center in Barcelona (Spain) between January 2017 and February 2020. Screening results were analyzed using binary logistic regression with adjustment for symptoms, geographic origin, and time since arrival. RESULTS: We studied 289 UASC (88.9% males; median age, 17 years). At least one infection was diagnosed in 136 minors (47.1%). There was a high prevalence of intestinal parasites (22.8%), latent tuberculosis infection (22.5%), and hepatitis B (5.2%), even in asymptomatic individuals, and especially among UASC from sub-Saharan Africa (odds ratio, 2.5; 95% confidence interval, 1.5-4.0, P < 0.001). We did not observe a significant association between clinical symptoms and the presence of infection or differences in the prevalence of different infections according to number of months since arrival. Protection against hepatitis B virus (36%), measles (80%), and varicella (83%) was suboptimal. CONCLUSIONS: Our results highlight the importance of screening and vaccination programs for UASC arriving in Europe, especially border countries. Protocols should be adjusted according to geographic origin. Absence of symptoms does not necessarily rule out infection, highlighting the importance of screening in asymptomatic minors. These programs are a public health priority and should not be neglected during the current COVID-19 pandemic.

Covid-19: Medical Decisions, Mandates, and High-Risk Minors.

Kensey Dishman was unvaccinated when she contracted Covid-19 at thirteen years old. She also had asthma and is now dead. Her divorced parents disagreed about whether Kensey should be vaccinated, and her father suggested that it was Kensey's own choice to refuse vaccination. This situation is as complicated as it is tragic, and it raises a number of legal and ethical issues regarding medical decision-making for minors, parental rights, vaccination mandates, and individual freedom versus government interests in protecting minors as well as public health. This commentary explores these issues and highlights potential sources of liability for those involved in Kensey's treatment decisions given her high-risk for complications from Covid-19.

The impact of the COVID-19 pandemic on abortion care utilization and disparities by age.

BACKGROUND: A variety of state-level restrictions were placed on abortion care in response to the COVID-19 pandemic, leading to drops in utilization and delays in time to abortion. Other pandemic-related factors also may have impacted receipt of abortion care, potentially exacerbating existing barriers to care. Massachusetts is an ideal setting to study the impact of these other pandemic-related factors on abortion care utilization because there was no wide-scale abortion policy change in response to the pandemic. OBJECTIVE: This study aimed to evaluate the impact of the COVID-19 pandemic on abortion care utilization and disparities in utilization by patient age in Massachusetts. STUDY DESIGN: Using the electronic medical records from all abortions that occurred at the Planned Parenthood League of Massachusetts from May 1, 2017 through December 31, 2020 (N=35,411), we performed time series modeling to estimate monthly changes in the number of abortions from the expected counts during the COVID-19 pandemic. We also assessed if legal minors (<18 years) experienced delays in time to abortion, based on gestational age at procedure, and whether minors were differentially impacted by the pandemic. RESULTS: There were 1725 less abortions than expected, corresponding to a 20% drop, from March 2020 to December 2020 (95% prediction interval, -2025 to -1394) with 888 less (20% reduction) abortions among adults, 792 (20% reduction) less among young adults, and 45 (27% reduction) among minors. Adults and young adults experienced significant reductions in the number of abortions beginning in March 2020, whereas decreases among minors did not begin until July 2020. The rate of abortions occurring ≥12 weeks gestational age was unchanged during the COVID-19 pandemic among minors (adjusted rate ratio, 0.92; 95% confidence interval, 0.55-1.51) and among adults (adjusted rate ratio, 0.92; 95% confidence interval, 0.78-1.09). Young adults had a lower rate of second trimester abortion during the pandemic (adjusted rate ratio, 0.79; 95% confidence interval, 0.66-0.95). CONCLUSION: Despite uninterrupted abortion service provision, abortion care utilization decreased markedly in Massachusetts during the pandemic. There was no evidence of an increase in second trimester abortions in any age group. Further research is needed to determine if a decline in the pregnancy rate or other factors, such as financial and travel barriers, fear of infection, or privacy concerns, may have contributed to this decline.

Tele-forensic interviewing can be a reasonable alternative to face-to-face interviewing of child witnesses.

OBJECTIVE: Tele-forensic interviews have the potential to aid investigations when children live far from interviewers, there is a risk of disease transmission, or when expertise is not locally available. However, it is unknown whether tele-forensic interviewing is an effective alternative to face-to-face interviewing, particularly for children most prone to suggestibility and lapses of attention. HYPOTHESES: Previous studies suggested that school-age children would provide similar amounts of information across interview modes but provided no basis for predicting how misinformation impacts accuracy across modes or how 4- and 5-year-olds would react to tele-forensic interviewing. METHOD: Children (4-8 years, N = 261, Mage = 6.42 years, 48% female) interacted with male assistants who violated a no-touching rule, parents read children a book containing misinformation about that event, and female assistants conducted interviews (usually 2 weeks after the event) face-to-face or via a video conference application. RESULTS: The children were more talkative during a practice narrative phase when interviewed face-to-face rather than on screen (incidence rate ratio [IRR] = 1.26, 95% CI [1.06, 1.51]), and 4-, 5-, and 6-year-olds said more in response to open-ended prompts when interviewed face-to-face (IRR = 1.50, 95% CI [1.08, 2.09]). Children younger than 7 years also disclosed the face touch and noncompleted handshake in response to earlier and less directive prompts when interviewed face-to-face, rs(53) = .28, p = .037, and rs(48) = .33, p = .021, respectively. Children 8 years and older, however, disclosed the face touch more readily when they spoke on screen, rs(28) = -.38, p = .036, and older 7-year-olds and 8-year-olds disclosed the noncompleted handshake more readily on screen, rs(30) = -.36, p = .042. Across interview modes, children reported comparable numbers of touch events, however, and were equally accurate on challenging source-monitoring and detail questions. CONCLUSIONS: Tele-forensic interviewing can be a reasonable alternative to face-to-face interviewing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The right to respect for family life, consent, minors and Gillick competence.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the statement made by the UK vaccines minister that healthy 12-15-year-olds could override their parents' decision on coronavirus vaccination.

Admission of a minor to a psychiatric hospital under Polish law. Part I. / Przyjecie maloletniego do szpitala psychiatrycznego w mysl polskiego prawa. Czesc I.

Within the scope of mental health protection, numerous practical problems arise concerning the issue of providing health services to a minor. Admission of a minor to a psychiatric hospital is associated in practice with numerous doubts. This part of the article describes the conditions of admission to hospital with the consent of the patient. It distinguishes and accurately describes situations where a minor is under or over 16 years of age. In addition, it explains situations where there is a contradiction of declarations of will by legal guardians in relation to admission, their inability to perform legal acts, or a contradiction of the statements of the minor and guardian. It also addresses the aspect of receiving written consent during the COVID-19 epidemic.

The Psychological Toll of COVID-19 on Children.

Pediatric mental health ED visits are sharply up as is the intensity of symptoms.

Impact of the COVID-19 Pandemic on Habilitating Residential Communities for Unaccompanied Minors during the First Lockdown in Italy: The Educators' Relational Perspective.

(1) Background: Italian residential communities for unaccompanied minors suffered a long period of closure during the SARS-COV2 lockdown. Professional educators who work inside these institutions with the aim to habilitate children toward life-span achievements faced a great challenge and responsibility during this period. In this context, the psychological well-being and development of unaccompanied children were at high risk. The aim of this study was to investigate the impact of the lockdown on children living in residential communities from the educators' perspective and to explore whether the educators' relational lens was related to their perception and sense-making. (2) Methods: We conducted a mix-method study enrolling 21 educators in 10 residential communities who completed an interview and a self-construal scale. (3) Results: The interview was analyzed by a qualitative content method revealing 10 themes (social relationships, stand-by, emotions, new activities, new norms acceptance, end of lockdown, time, space, resilience, and achievements). Moreover, correlation analyses were performed to test the possible association between RISC and themes that emerged from the interviews, showing significant associations with four interview themes. (4) Conclusions: Our study highlights considerable lockdown effects on residential communities and the importance of educators' relational approach, a tool for habilitating children and a protective factor against emotional overwhelming.

Enrolling Minors in COVID-19 Vaccine Trials.

It is widely agreed that an effective response to the coronavirus disease 2019 pandemic needs to include a vaccine that is safe and effective for minors. However, many current vaccine trials have no plans for when to enroll minors. Others have recently proposed enrolling minors as young as 12 years old. This lack of a systematic approach raises 2 concerns. Waiting too long to enroll minors could unjustly deny minors and their families the benefits of a vaccine and has the potential to delay an effective response to the pandemic by a year or longer. At the same time, enrolling minors too soon runs the risk of exposing them to excessive risks. With these concerns in mind, in the present article, we propose recommendations for when and how to enroll minors in vaccine trials for the coronavirus disease 2019.